Schiavina Riccardo, Borghesi Marco, Dababneh Hussam, Rossi Martina Sofia, Pultrone Cristian Vincenzo, Vagnoni Valerio, Chessa Francesco, Bianchi Lorenzo, Porreca Angelo, Mottrie Alexandre, Brunocilla Eugenio
University of Bologna, S. Orsola-Malpighi Hospital, Dept. of Urology, Bologna; Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna.
Arch Ital Urol Androl. 2018 Mar 31;90(1):1-7. doi: 10.4081/aiua.2018.1.1.
The success of Robot Assisted Laparoscopic Prostatectomy (RALP) is mainly due to his relatively short learning curve. Twenty cases are needed to reach a "4 hours-proficiency". However, to achieve optimal functional outcomes such as urinary continence and potency recovery may require more experience. We aim to report the perioperative and early functional outcomes of patients undergoing RALP, after a structured modular training program.
A surgeon with no previous laparoscopic or robotic experience attained a 3 month modular training including: a) e-learning; b) assistance and training to the operating table; c) dry console training; d) step by step in vivo modular training performing 40 surgical steps in increasing difficulty, under the supervision of an experienced mentor. Demographics, intraoperative and postoperative functional outcomes were recorded after his first 120 procedures, considering four groups of 30 cases.
All procedures were completed successfully without conversion to open approach. Overall 19 (15%) post operative complications were observed and 84% were graded as minor (Clavien I-II). Overall operative time and console time gradually decreased during the learning curve, with statistical significance in favour of Group 4. The overall continence rate at 1 and 3 months was 74% and 87% respectively with a significant improvement in continence rate throughout the four groups (p = 0.04). Considering those patients submitted to nerve-sparing procedure we found a significant increase in potency recovery over the four groups (p = 0.04) with the higher potency recovery rate up to 80% in the last 30 cases.
Optimal perioperative and functional outcomes have been attained since early phase of the learning curve after an intensive structured modular training and less than 100 consecutive procedures seem needed in order to achieve optimal urinary continence and erectile function recovery.
机器人辅助腹腔镜前列腺切除术（RALP）的成功主要得益于其相对较短的学习曲线。达到“4小时熟练程度”需要20例手术经验。然而，要实现诸如尿失禁和性功能恢复等最佳功能结果可能需要更多经验。我们旨在报告接受结构化模块化培训计划后行RALP患者的围手术期和早期功能结果。
一名此前无腹腔镜或机器人手术经验的外科医生接受了为期3个月的模块化培训，包括：a）电子学习；b）手术台辅助与培训；c）模拟控制台训练；d）在经验丰富的导师监督下，逐步进行体内模块化训练，执行40个难度递增的手术步骤。在其完成的前120例手术后，记录了人口统计学数据、术中及术后功能结果，分为四组，每组30例。
所有手术均成功完成，未转为开放手术。共观察到19例（15%）术后并发症，84%为轻度（Clavien I-II级）。在学习曲线期间，总体手术时间和控制台操作时间逐渐减少，第4组具有统计学意义。1个月和3个月时的总体尿失禁率分别为74%和87%，四组的尿失禁率均有显著改善（p = 0.04）。在接受保留神经手术的患者中，我们发现四组的性功能恢复有显著提高（p = 0.04），最后30例患者的性功能恢复率高达80%。
经过强化结构化模块化培训，在学习曲线的早期阶段就取得了最佳的围手术期和功能结果，似乎只需连续进行不到100例手术就能实现最佳的尿失禁和勃起功能恢复。
